Research Article
Hematopoietic Stem Cell Transplant in Older Patients with MDS and Co-existing Myelofibrosis
Saste Abhijit, Meredith Mahan, Nalini
Janakiraman, Shatha Farhan, Susan
Michalowski, Edward Peres
Correspondence Address :
Edward Peres
Division of
Hematology Oncology
Stem Cell Transplant, Henry Ford Cancer Institute
USA
Tel: 313-916-5002
Email:
Eperes1@HfHS.org
Received on: July 05, 2017, Accepted on: July 19, 2017, Published on: July 28, 2017
Citation: Saste Abhijit, Meredith Mahan, Nalini Janakiraman, Shatha Farhan, Susan Michalowski, Edward Peres (2017). Hematopoietic Stem Cell
Transplant in Older Patients with MDS and Co-existing Myelofibrosis
Copyright: 2017 Edward Peres et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Abstract
Background: Myelodysplastic syndrome with co-existing bone marrow fibrosis is associated with a dismal prognosis with conventional therapy. Allogeneic hematopoietic stem cell transplant (HSCT) offers the sole treatment approach that offers curative potential. HSCT has been utilized in younger patients with this disorder however with the advent of reduced intensity conditioning (RIC) regimens it has allowed for expansion of this application up to the age of 70 years. The data on the outcomes of patients of older age undergoing RIC for MDS with fibrosis is unknown.
Methods: To identify patients who received HSCT at our center with the diagnosis of myelodysplastic syndrome with co-existing fibrosis (n=15). We conducted a retrospective review in regards to HSCT specific variables influencing outcome and classified them according to their age, degree of bone marrow fibrosis, cytogenetic abnormality, Jak2, engraftment, transplant-related mortality, relapse and overall survival.
Results: Higher median age, high risk cytogenetics and high grade bone marrow fibrosis in our study population was not associated with inferior survival in univariate analysis. The cumulative incidence of engraftment achieved at day+30 based on chimerism was 72.7% the 2-year overall survival was 78% in the patient cohort. There were no patients who developed graft failure and no reported cases of relapse post- transplant.
Conclusions: Among patients with myelodysplastic syndrome and co-existing bone marrow fibrosis, even in patients with older age, higher grade of marrow fibrosis or cytogenetic abnormality, overall survival after hematopoietic stem cell transplantation was not inferior. HSCT should be offered to patients even with older age and significant marrow fibrosis.